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By Greenpeace Report
Alternatives to chlorine
PVC or vinyl is the main source of chlorine in hospital waste incinerators, and is mainly found in hospital products and packaging. Approximately 9.4% of all infectious waste is PVC.
Hospital waste incinerators represent one of the largest sources of dioxins, for this reason some countries are applying restrictive measures to this waste treatment system. As a consequence, many hospitals have closed their own incinerator furnaces and send their waste to incineration with more pollution control devices.
However, this is not the right solution either. There are disposal treatments for 99.7% of hospital waste that do not generate dioxins. More and more hospitals in Austria, Germany and Denmark are deciding to reduce the quantity and nature of their waste, using reusable hospital products that can be sterilized. The substitution of PVC products is linked to the programs for the prevention of waste and separation for recycling. The progressive elimination of PVC in these hospitals has taken place for several reasons: either because urban waste incinerators do not accept waste that exceeds certain percentages chlorine, or only accept them at a considerable cost increase; or because incineration plants have had to close due to stricter emissions regulations. Citizen demands have also played a fundamental role in this change.
There are other reasons to substitute vinyl products in hospitals. Medical objections against the use of PVC are mainly based on the migration of the plasticizer DEHP. This additive is soluble in fat-containing fluids, such as blood, and can cause diseases of the liver, skin, and cardiovascular system. Animal experiments have shown a significant increase in liver tumors, when DEHP is added to the food of mice and rats; therefore this additive is classified as "carcinogenic in animal experiments" and, due to the lack of adequate epidemiological studies in humans, it is classified as "possible human carcinogen." Recent evidence shows its potential as a hormone disruptor.
At present, the use of alternatives to PVC represents an increase in costs of 20-30%, although the savings in current incineration rates and in the emission of dioxins must also be taken into account.
PVC-free hospital products:
|Use of PVC||Alternatives|
|Exam Gloves||PE and / or PE copolymers are recommended. Latex is of the highest quality and has been tested for its barrier against viruses.|
|Shoe covers||PE shoe covers for single use cases.|
|Aprons||Fabric alternatives for low pollution areas; PE cutlery for operating rooms.|
|Mattress covers||Alternative plastics such as PE and rubber only where necessary.|
Washable microfibers such as "Kortex" or "Geritex" that are more comfortable for patients.
|Diapers, napkins||They already exist PVC free|
|Urinals / Wedges||Stainless steel|
|Syringes||PE and PP, natural rubber and in some cases ABS.|
Glass syringes for blood collection.
|Infusion sets, bottles and / or bags, connected to apparatus, tubes, pieces of tubes.||PVC-free infusion sets: glass for some uses, PP, PE, PE / PA, EVA, PCCE and PSU, as well as multi-use suspension items for the most common infusion receptacles.|
|Tubes||EVA and EVA, PCCE or PE copolymers. In other fields of application, for example for breathing, silicone or rubber tubes.|
|Gastric tests||Silicone and PP|
|Catheters||Silicone and latex|
|Drain bottles, bags||Glass, PE, PE / PP|
|Scalpels (available with PVC handles)||Metal handles with interchangeable sharp blades.|
|Face masks||Rubber, silicone and latex|
|Blood bags for special cases||US prototype supplier|
|Packaging||Virtually all PVC free. PP pill / capsule packaging|
In other fields of application, for example for breathing, silicone or rubber tubes. Gastric tests Silicone and PP Catheters Silicone and latex Drainage bottles, bags Glass, PE, PE / PP Scalpels (available with PVC handles) Metal handles with interchangeable sharp blades. Masks Rubber, silicone and latex Blood bags for special cases Supplier with prototype from USA Packaging Virtually all PVC free. PP PE -Polyethylene, PP- Polypropylene, EVA - Ethyl Vinyl Acetate, PSU - Polysulfon, PCCE - Polycyclohexane-dimethyl cyclohexane - elastomeric dicarboxycyclate, PC - Polycarbonate, ABS - Acrylonitrile Butadiene Styrene, PA - Acrylonitrile Butadiene Styrene.
In general, 85% of the total hospital waste is made up of the mixture of paper, plastic, glass, metal and food, with the same characteristics as the waste that originates from any home. The remaining 15% is defined as infectious and must be sterilized before management. Dioxin-free disposal means exist for 99.7% of the remaining hospital waste. Non-hazardous waste can be treated within a MSW recycling plan.
For the management of infectious waste there are different alternative dioxin-free methods at competitive costs.
b) Microwave disinfection
c) Steam sterilization
It is estimated that 45% of infectious medical equipment in western US hospitals is reused, through autoclave sterilization. These devices are commercially available in different sizes, from the smallest to the industrial units.
This type of treatment is also used to sterilize hospital waste. The process is carried out in chambers in which steam is introduced under pressure, at temperatures between 120º and 1650ºC, for 30 to 90 minutes. The steam ensures the destruction of bacteria and pathogenic microorganisms. With this treatment, waste is reduced by 75% of its volume and can be deposited directly in a landfill or compacted. This waste represents less than 0.2% of urban solid waste that is deposited in the landfill.
According to a recent study of hospitals that have installed autoclaves, they are easier to use than incinerators.
Cost benefits of autoclaves
In 1996, a study conducted by the Center for Natural Systems Biology in New York, comparing the annual operating costs of hospital incinerators and autoclaves in the Great Lakes region of North America, found to the conclusion that the use of autoclaves was cheaper.
Total estimated costs for alternative methods of managing infectious and pathogenic hospital waste, in the 609 hospitals in the Great Lakes region. (1994)
|METHOD||ANNUAL OPERATING COST|
(millions of dollars)
|Existing incinerators (uncontrolled)||9.8|
|Existing incinerators that necessarily need an upgrade.||55.5|
|Autoclaves with a small infectious waste incinerator||23.0|
|Shipments to commercial plants||28.0|
In this conversion the costs ($ 2.9 million) are still lower than the annual operating cost of incineration with the mandatory emissions update ($ 3.4 million per year).
b) Microwave disinfection
The microwave system is economically competitive and versatile. Various studies in Europe have shown that there is no emission since the internal heating system is closed. Consequently, there is no need for contamination control devices. Microwave disinfection treats hospital waste with humid heat and at a temperature of 940ºC. The equipment can be installed inside or outside of stationary or mobile units. Waste is reduced by 80% in volume and can be landfilled.
c) Steam sterilization
This technology consists of a high temperature crusher and a sterilization unit. In the shredder, the organic liquids evaporate and the solids pass directly to gas, by the action of steam at high temperatures, between 500ºC and 700ºC. In one hour, medical waste is melted into a sterile mass, which is subsequently cooled, and is collected in a container or shredded in a shredder. The process can reduce the original volume of hospital waste by 50% to 80%.